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8 • Bay Area Reporter • September 19-25, 2013
New Waddell health clinic officially opens by Seth Hemmelgarn
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San Francisco health clinic that provides care to some of the city’s poorest residents, including transgender patients and people living with HIV, recently marked some upgrades in services and its physical space. Primary care services from the Tom Waddell Health Center, named after the late physician and founder of the Gay Games, and the Housing and Urban Health Center have been combined, renamed, and moved into a new location at 230 Golden Gate Avenue. Mayor Ed Lee and others marked the grand opening at a ribbon cutting ceremony Wednesday, September 11. The new agency is the Tom Waddell Urban Health Clinic. “The Tom Waddell staff has been a national leader in providing homeless/HIV and transgender primary care services for many years,” Health Director Barbara Garcia said in a statement. “We are proud to provide our clients with this beautiful, stateof-the-art facility and health clinic. Our patients deserve it and our committed employees deserve it.” Dr. Joseph Pace is director of primary care homeless services for the Department of Public Health, which
Jane Philomen Cleland
Mayor Ed Lee, third from left, cuts the ribbon signaling the official opening of the new Tom Waddell Urban Health Clinic. Joining the mayor at the September 11 ceremony were, from left, Supervisors David Campos and Jane Kim, medical director Dr. Joseph Pace, Health Director Barbara Garcia, and health department officials Marcellina Ogbu and Mark Alstead.
operates the clinic, and also serves as Tom Waddell’s medical director. Pace called the new space “stateof-the-art,” and said the upgrade is meant to demonstrate the city and health department’s “commitment to providing high quality care to this
vulnerable population,” and to offer an environment that is “healing and welcoming” and acknowledges people’s dignity “no matter who they are. “The biggest change” at the clinic “is the move toward team-based care, which means that a patient is linked
to a team of staff that includes the medical provider, nursing staff, medical assistant, and behavioral health specialist,” he said. Before, “We weren’t always as coordinated as we could have been,” he said, and each patient now works with the same team throughout their care process. The model “highlights that the relationships we build with our clients are really at the center of the healing process, because often, our patients are socially isolated, have been estranged from their families, and because of their multiple medical, mental health, and substance abuse issues, have often been shunned or marginalized in their experiences to navigate systems of care,” said Pace, who is gay. The clinic, which has a budget of about $10 million and approximately 4,500 to 5,000 patients, has also brought together a psychiatry team and social work team and integrated those providers into its primary care services. Behavioral and mental health issues are central to many of the problems that patients cope with, said Pace. Among things that aren’t changing, dental and urgent care services will continue to be available at 50 Ivy (Lech Walesa) Street, the Tom
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Waddell clinic’s former home. Additionally, Tom Waddell has approximately 15 community sites through which it offers services at homeless shelters and other community-based organizations. More developments lie ahead for the agency. The clinic is preparing to mark the 20th anniversary of its transgender care clinic. Pace said Tom Waddell received two new federal grants this year. He said one focuses on transgender women of color, and the other is meant to expand engagement with “hard to reach” people who are living with HIV and homeless. Full services began July 9, but the grand opening was held last week so that painting and other work could be done, and so that as many people could attend the ceremony as possible. In a bulletin explaining the changes that was released this summer, clinic officials stated, “Our staff will be the same and we will continue to provide outstanding care services.” They also pledged to make it easier to get an appointment and shorter wait times. Drop-ins are accepted but appointments are encouraged. The clinic can be reached at (415) 355-7400.t
Seniors, disabled face Medi-Cal asset caps by Seth Hemmelgarn
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nder the Affordable Care Act, seniors and people with disabilities who receive Medi-Cal will continue to have to meet asset limits that can force them to deplete their savings. Through the national health care reform law, much of which goes into effect January 1, some non-disabled people between the ages of 19 and
64 whose income isn’t more than 138 percent of the federal poverty guideline are exempt from the caps. However, others, including many people who are living with AIDS, will continue being subjected to caps of $2,000 in assets for individuals and $3,000 for married couples. The federal poverty guideline for individuals is $11,490. Brian Basinger, director of the AIDS Housing Alliance-San Fran-
cisco, said the caps create “a structural barrier to these vulnerable populations being able to have a nest egg to fall back on when they experience hard times.” But Basinger was optimistic that lawmakers could be persuaded to change the policy. “This is just a law that was conceived and crafted by our elected officials in Washington,” he said. “It is ink on a piece of paper, and so what-
ever has been done can be undone. This does not have to be our reality, and we have to push back and get them to change it, say, ‘We’re sorry, this is a mistake,’ and do it over.” Andy Chu, managing legal director for Positive Resource Center, a San Francisco nonprofit that provides benefits counseling and employment services for people with or at risk for HIV/AIDS, expressed some hope that change was possible, as well. “What we don’t know is whether people can transition” into the section of Medi-Cal that doesn’t take into account peoples’ assets, he said. If the caps do stay in place, “The impact will be that people who are disabled and seniors will still have to live in poverty in order to have health insurance,” said Chu. Basinger reached out to the staff of House Minority Leader Nancy Pelosi (D-San Francisco), a longtime advocate for people with HIV and AIDS, and warned that keeping the limits could help lead to more people becoming homeless, since they’re “not allowed to have any cushion.” Pelosi spokesman Drew Hammill gave no indication that there would be change any time soon. “While we are always looking for ways to strengthen” the Affordable Care Act, “Medicaid has always had strict assets tests,” said Hammill in an email exchange with the Bay Area Reporter. “The Congress took steps in the law to try to diminish gaps in coverage, but we were not able to end asset tests for the elderly and disabled, including those living with AIDS.” (Medi-Cal is the California version of the federal Medicaid program for poor people.) Hammill blamed the GOP for the limits remaining. “House Republicans have stated repeatedly that their number one legislative priority is to repeal the Affordable Care Act – not strengthen it,” he said. “As you know, they are in the majority in the House.” One group the limits are troubling for is people with disabilities who are considering returning to work and have to look at whether their paycheck plus their disability check will put them over the $2,000 asset cap. “When you look at them from a logical point of view,” these factors
Jane Philomen Cleland
AIDS Housing Alliance director Brian Basinger
“are things that can be managed,” said Basinger. “But what people don’t necessarily understand is how the fear of making a mistake that can cause you to lose your Medi-Cal that you need to stay alive ... reverberates and affects people emotionally. That fear paralyzes people and keeps them stuck in ways that maintain their vulnerability.” Basinger’s had at least one client spend money on a TV and shoes in order to be able to hold onto his benefits. Chu has reached out to the city for an interpretation of whether people will be able to transition into the non-asset cap part of Medi-Cal, but he said he hasn’t received an official answer. A call to San Francisco’s Human Services Agency, which is responsible for enrolling people in Medi-Cal in the city, wasn’t returned. Hammill sought to remind people of some positive developments related to national health care reform. Among other benefits, the act “will provide significant protections for those living with HIV/AIDS by dramatically increasing access to Medicaid,” which “will no longer demand that you meet the strict tests to prove disability status or that you have children. Single and childless couples will be eligible for Medicaid,” he said, adding, “We will continue to work to strengthen the Affordable Care Act.”t